{"id":28031,"date":"2023-04-24T22:31:25","date_gmt":"2023-04-24T15:31:25","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28031"},"modified":"2023-04-24T22:32:16","modified_gmt":"2023-04-24T15:32:16","slug":"tiep-can-dieu-tri-ha-natri-mau-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/tiep-can-dieu-tri-ha-natri-mau-cap\/","title":{"rendered":"Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb H\u1ea1 Natri m\u00e1u c\u1ea5p"},"content":{"rendered":"<p><strong>Nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u c\u1ea5p, c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1eb7ng (l\u01a1 m\u01a1, h\u00f4n m\u00ea, co gi\u1eadt)\u00a0 c\u1ea7n theo d\u00f5i ch\u0103m s\u00f3c c\u1ea5p c\u1ee9u s\u00e1t sao. H\u1ea1n ch\u1ebf n\u01b0\u1edbc, m\u1eb7c d\u00f9 kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 \u0111i\u1ec1u\u00a0 ch\u1ec9nh h\u1ea1 natri m\u00e1u nhanh ch\u00f3ng \u0111\u1ee7 \u0111\u1ec3 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ph\u00f9 n\u00e3o, c\u0169ng s\u1ebd\u00a0 ng\u0103n c\u1ea3n h\u1ea1 natri m\u00e1u di\u1ec5n ti\u1ebfn x\u1ea5u h\u01a1n.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-28033 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/images-8.jpg\" alt=\"minh-hoa-ha-natri-mau\" width=\"259\" height=\"195\" \/><\/p>\n<h2>1. T\u1ed5ng quan t\u00ecm nguy\u00ean nh\u00e2n h\u1ea1 natri m\u00e1u<\/h2>\n<p>Khi c\u00f3 nh\u1eefng bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c\u00a0 tri\u1ec7u ch\u1ee9ng \u0111\u00e1ng k\u1ec3 c\u1ee7a th\u1ea7n kinh TW, nh\u01b0 \u1ee9c ch\u1ebf n\u1eb7ng tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n, co gi\u1eadt,\u00a0 ho\u1eb7c b\u1eb1ng ch\u1ee9ng kh\u00e1c c\u1ee7a t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd th\u00ec ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u v\u1edbi saline\u00a0 \u01b0u tr\u01b0\u01a1ng. H\u1ea1 natri m\u00e1u c\u1ea5p, nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 do b\u1ea5t k\u00ec nguy\u00ean nh\u00e2n h\u1ea1 natri\u00a0 m\u00e1u n\u00e0o, nh\u01b0ng nh\u1eefng nguy\u00ean nh\u00e2n hay g\u1eb7p nh\u1ea5t l\u00e0:<\/p>\n<ul>\n<li>C\u00e1c d\u1ecbch nh\u01b0\u1ee3c tr\u01b0\u01a1ng (v\u00ed d\u1ee5, 0.45% saline, D5 0.45% saline, D5W) s\u1eed d\u1ee5ng\u00a0 h\u1eadu ph\u1eabu ho\u1eb7c trong b\u1ed1i c\u1ea3nh thi\u1ebfu h\u1ee5t th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o\u00a0(extracellular fluid volume \u2013 ECVF).<\/li>\n<li>H\u1ed9i ch\u1ee9ng ti\u1ebft ADH kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi th\u1eeba c\u1ea5p t\u00ednh l\u01b0\u1ee3ng n\u01b0\u1edbc \u0111\u01b0a v\u00e0o<\/li>\n<li>Ch\u1ee9ng kh\u00e1t nhi\u1ec1u nguy\u00ean ph\u00e1t d\u1eabn t\u1edbi ng\u1ed9 \u0111\u1ed9c n\u01b0\u1edbc c\u1ea5p \u1edf b\u1ec7nh nh\u00e2n t\u00e2m\u00a0 th\u1ea7n. \u0110\u1ec3 c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n h\u1ea1 natri m\u00e1u, n\u00f3i chung c\u1ea7n ph\u1ea3i c\u00f3 s\u1ef1 suy y\u1ebfu kh\u1ea3\u00a0 n\u0103ng b\u00e0i ti\u1ebft n\u01b0\u1edbc b\u00ean c\u1ea1nh vi\u1ec7c t\u0103ng n\u01b0\u1edbc \u0111\u01b0a v\u00e0o.<\/li>\n<li>Thi\u1ebfu h\u1ee5t ECFV (th\u01b0\u1eddng th\u1ee9 ph\u00e1t sau n\u00f4n k\u00e9o d\u00e0i m\u00e0 ti\u1ebfp t\u1ee5c d\u00f9ng n\u01b0\u1edbc).\u00a0 Nh\u00ecn chung lo\u1ea1i h\u1ea1 natri m\u00e1u n\u00e0y s\u1ebd \u0111\u00e1p \u1ee9ng v\u1edbi NaCl 0.9% v\u00e0 kh\u00f4ng d\u00f9ng\u00a0 saline \u01b0u tr\u01b0\u01a1ng.<\/li>\n<li>Cyclophosphamide \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (t\u0103ng hi\u1ec7u qu\u1ea3 ADH)<\/li>\n<\/ul>\n<h2><strong>2. S\u1eed d\u1ee5ng saline 3% nh\u01b0 th\u1ebf n\u00e0o\u00a0\u00a0<\/strong><\/h2>\n<p>C\u00f3 nh\u1eefng h\u01b0\u1edbng d\u1eabn quan tr\u1ecdng \u0111\u1ed1i v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng saline \u01b0u tr\u01b0\u01a1ng.\u00a0 Nguy c\u01a1 ch\u00ednh c\u1ee7a s\u1eed d\u1ee5ng saline 3% l\u00e0 \u0111i\u1ec1u ch\u1ec9nh qu\u00e1 nhanh ho\u1eb7c qu\u00e1 m\u1ee9c h\u1ea1 natri\u00a0 m\u00e1u g\u00e2y ra ODs. Quan tr\u1ecdng l\u00e0 ph\u1ea3i ti\u1ebfn h\u00e0nh li\u1ec7u ph\u00e1p \u201cc\u00e1 nh\u00e2n h\u00f3a\u201d cho m\u1ed7i b\u1ec7nh\u00a0 nh\u00e2n, v\u00e0 \u0111i\u1ec1u ch\u1ec9nh v\u1edbi nh\u1eefng thay \u0111\u1ed5i l\u00e2m s\u00e0ng. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 nh\u1eefng h\u01b0\u1edbng d\u1eabn an\u00a0 to\u00e0n:<\/p>\n<ul>\n<li>Ch\u1ec9 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1eb7ng. Nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng tri\u1ec7u\u00a0 ch\u1ee9ng ho\u1eb7c tri\u1ec7u ch\u1ee9ng nh\u1eb9 n\u00f3i chung kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb v\u1edbi saline 3%.<\/li>\n<li>Nh\u00ecn chung, \u0111i\u1ec1u ch\u1ec9nh n\u1ed3ng \u0111\u1ed9 natri kh\u00f4ng nhanh h\u01a1n 1 mEq\/gi\u1edd ban \u0111\u1ea7u cho \u0111\u1ebfn khi t\u0103ng \u0111\u01b0\u1ee3c 6-8 mEq\/L, sau \u0111\u00f3 0.5 mEq\/L (ho\u1eb7c \u00edt h\u01a1n) m\u1ed7i gi\u1edd.<\/li>\n<li>T\u0103ng n\u1ed3ng \u0111\u1ed9 natri 6- 8 mEq\/L n\u00ean l\u00e0 \u0111\u1ee7 \u0111\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea5p. M\u1ed9t\u00a0 khi c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea3i thi\u1ec7n, saline 3% n\u00ean ch\u1eadm l\u1ea1i ho\u1eb7c d\u1eebng.<\/li>\n<\/ul>\n<ul>\n<li>Kh\u00f4ng cho ph\u00e9p t\u0103ng n\u1ed3ng \u0111\u1ed9 natri qu\u00e1 10- 12 mEq\/L trong 24 gi\u1edd \u0111\u1ea7u.<\/li>\n<li>S\u1eed d\u1ee5ng saline 3% can \u0111\u1ea7u 50- 100 ml\/gi\u1edd nh\u00ecn chung an to\u00e0n cho giai \u0111o\u1ea1n\u00a0 ng\u1eafn \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n tri\u1ec7u ch\u1ee9ng n\u1eb7ng c\u00f3 k\u00edch th\u01b0\u1edbc \u201ctrung b\u00ecnh\u201d, cho \u0111\u1ebfn\u00a0 khi t\u00ednh to\u00e1n ph\u00f9 h\u1ee3p \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u1ed1c \u0111\u1ed9 s\u1eed d\u1ee5ng ch\u00ednh x\u00e1c.<\/li>\n<li>R\u1ea5t c\u1ea9n th\u1eadn v\u1edbi ph\u1ee5 n\u1eef v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111au m\u1ea1n t\u00ednh, ch\u1eb3ng h\u1ea1n nh\u01b0\u00a0 nh\u1eefng b\u1ec7nh nh\u00e2n u\u1ed1ng r\u01b0\u1ee3u, ung th\u01b0, v\u00e0 c\u00f3 ng\u1eebng tim g\u1ea7n \u0111\u00e2y v\u00ec h\u1ecd c\u00f3 nguy\u00a0 c\u01a1 b\u1ecb ODs.<\/li>\n<li>Truy\u1ec1n ch\u1eadm ho\u1eb7c d\u1eebng truy\u1ec1n ngay khi c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n. <em>M\u1ee5c\u00a0 ti\u00eau kh\u00f4ng ph\u1ea3i l\u00e0 \u0111i\u1ec1u ch\u1ec9nh gi\u00e1 tr\u1ecb natri huy\u1ebft thanh m\u1ed7i gi\u00e2y m\u00e0 l\u00e0 gi\u1ea3m nh\u1eb9\u00a0 ph\u00f9 n\u00e3o.\u00a0\u00a0<\/em><\/li>\n<li>Xem x\u00e9t t\u00ecnh tr\u1ea1ng suy tim xung huy\u1ebft. M\u1ed9t s\u1ed1 nh\u00e0 l\u00e2m s\u00e0ng cho l\u1ee3i ti\u1ec3u quai\u00a0 b\u00ean c\u1ea1nh saline 3% tr\u00e1nh qu\u00e1 t\u1ea3i ECFV v\u00e0 l\u00e0m t\u0103ng b\u00e0i ti\u1ebft n\u01b0\u1edbc.<\/li>\n<\/ul>\n<p><strong>L\u01b0u \u00fd<\/strong>: C\u00e1c l\u1ee3i ti\u1ec3u quai c\u00f3 th\u1ec3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 natri nhanh h\u01a1n d\u1ef1 ki\u1ebfn, do \u0111\u00f3 n\u1ed3ng\u00a0 \u0111\u1ed9 natri huy\u1ebft thanh ph\u1ea3i \u0111\u01b0\u1ee3c ki\u1ec3m tra r\u1ea5t th\u01b0\u1eddng xuy\u00ean.<\/p>\n<p>M\u1ed9t khi \u0111\u00e3 quy\u1ebft \u0111\u1ecbnh s\u1eed d\u1ee5ng saline \u01b0u tr\u01b0\u01a1ng, t\u1ed1c \u0111\u1ed9 truy\u1ec1n saline 3% c\u00f3 th\u1ec3\u00a0 \u0111\u01b0\u1ee3c t\u00ednh to\u00e1n nh\u01b0 sau:<\/p>\n<p><strong>2.1 \u00a0T\u00ednh s\u1ef1 \u201cthi\u1ebfu h\u1ee5t natri\u201d\u00a0\u00a0<\/strong><\/p>\n<p>T\u00ednh l\u01b0\u1ee3ng natri b\u1eb1ng mEq m\u00e0 n\u1ebfu t\u1ea5t c\u1ea3 n\u00f3 c\u00f2n \u1edf khoang d\u1ecbch ngo\u1ea1i b\u00e0o, s\u1ebd l\u00e0m\u00a0 t\u0103ng n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh l\u00ean m\u1ee9c mong mu\u1ed1n. H\u1ea1 natri m\u00e1u kh\u00f4ng ph\u1ea3i l\u00e0\u00a0 k\u1ebft qu\u1ea3 c\u1ee7a thi\u1ebfu h\u1ee5t natri, nh\u01b0 l\u00e0 thu\u1eadt ng\u1eef \u201cthi\u1ebfu h\u1ee5t natri\u201d. \u0110\u00e2y ch\u1ec9 l\u00e0 m\u1ed9t\u00a0 thu\u1eadt ng\u1eef, nh\u01b0ng n\u00f3 h\u1eefu \u00edch gi\u00fap ch\u00fang ta t\u00ednh to\u00e1n l\u01b0\u1ee3ng natri b\u1eb1ng mEq \u0111\u1ec3\u00a0 cung c\u1ea5p nh\u01b0 saline 3% \u0111\u1ec3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 natri l\u00ean m\u1ee9c mong mu\u1ed1n. \u00a0 \u0110\u1ec3 l\u00e0m \u0111i\u1ec1u n\u00e0y, tr\u01b0\u1edbc ti\u00ean \u0111\u1eb7t gi\u00e1 tr\u1ecb n\u1ed3ng \u0111\u1ed9 mong mu\u1ed1n natri huy\u1ebft thanh s\u1eed\u00a0 d\u1ee5ng c\u00e1c th\u00f4ng s\u1ed1 \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh an to\u00e0n \u0111\u00e3 th\u1ea3o lu\u1eadn \u1edf tr\u00ean, v\u00e0 <strong>th\u1eddi gian <\/strong>(t, t\u00ednh\u00a0 b\u1eb1ng gi\u1edd) t\u1ea1i gi\u00e1 tr\u1ecb m\u00e0 b\u1ea1n mong mu\u1ed1n v\u1edbi natri:<\/p>\n<ul>\n<li>Na<sup>+<\/sup><strong>(mEq <\/strong>v\u1edbi saline 3%) = ( [Na<sup>+<\/sup><sub>mong mu\u1ed1n<\/sub> ] &#8211; [Na<sup>+<\/sup><sub>\u0111o \u0111\u01b0\u1ee3c<\/sub>] ) X T\u1ed5ng n\u01b0\u1edbc c\u01a1 th\u1ec3\u00a0 \u01b0\u1edbc t\u00ednh<\/li>\n<li>\u0110i\u1ec1u n\u00e0y cho ta bi\u1ebft l\u01b0\u1ee3ng natri (mEq) \u0111\u1ec3 cung c\u1ea5p t\u1eeb saline 3% trong th\u1eddi\u00a0 gian t.<\/li>\n<\/ul>\n<p><strong>2.2 Thi\u1ebft l\u1eadp t\u1ed1c \u0111\u1ed9 truy\u1ec1n\u00a0<\/strong><\/p>\n<p>C\u00f3 513 mEq natri trong m\u1ed9t l\u00edt saline 3%. Do \u0111\u00f3, \u0111\u1ec3 nh\u1eadn \u0111\u01b0\u1ee3c th\u1ec3 t\u00edch saline 3%\u00a0 \u0111\u1ec3 cung c\u1ea5p trong th\u1eddi gian t, ta chia s\u1ed1 l\u01b0\u1ee3ng mEq natri c\u1ea7n cung c\u1ea5p (\u0111\u01b0\u1ee3c x\u00e1c\u00a0 \u0111\u1ecbnh \u1edf b\u01b0\u1edbc 1) cho 513 mEq\/L.<\/p>\n<p>Sau \u0111\u00f3 cung c\u1ea5p th\u1ec3 t\u00edch saline 3% n\u00e0y trong th\u1eddi gian t.<\/p>\n<p>N\u00f3i chung, s\u1eed d\u1ee5ng \u0111\u00fang saline \u01b0u tr\u01b0\u01a1ng s\u1ebd l\u00e0m gi\u1ea3m t\u1ea1m th\u1eddi ph\u00f9 n\u00e3o b\u1eb1ng\u00a0 c\u00e1ch d\u1ecbch chuy\u1ec3n n\u01b0\u1edbc ra kh\u1ecfi t\u1ebf b\u00e0o n\u00e3o. M\u1ed9t l\u1ee3i ti\u1ec3u quai c\u00f3 th\u1ec3 th\u1ea3i lo\u1ea1i n\u01b0\u1edbc\u00a0 th\u1eeba kh\u1ecfi c\u01a1 th\u1ec3. V\u00ec th\u1ebf, l\u1ee3i ti\u1ec3u quai th\u1ec9nh tho\u1ea3ng \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi saline 3% trong\u00a0 b\u1ed1i c\u1ea3nh h\u1ea1 natri c\u1ea5p, c\u00f3 tri\u1ec7u ch\u1ee9ng. Tuy nhi\u00ean, c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u quai c\u00f3 th\u1ec3 l\u00e0m\u00a0 t\u0103ng n\u1ed3ng \u0111\u1ed9 natri nhanh h\u01a1n d\u1ef1 ki\u1ebfn, do \u0111\u00f3 ph\u1ea3i ki\u1ec3m tra r\u1ea5t th\u01b0\u1eddng xuy\u00ean\u00a0 n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh.<\/p>\n<p><strong>L\u01b0u \u00fd: <\/strong>\u0110i\u1ec1u ch\u1ec9nh nhanh qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 g\u00e2y ra s\u1ef1 \u0111\u00e1nh gi\u00e1 qu\u00e1 cao c\u1ee7a t\u1ed5ng n\u01b0\u1edbc\u00a0 c\u01a1 th\u1ec3 c\u0169ng nh\u01b0 t\u00ednh to\u00e1n nh\u1ea7m s\u1ef1 \u201cthi\u1ebfu h\u1ee5t natri\u201d. C\u1ea9n th\u1eadn khi s\u1eed d\u1ee5ng <strong>0.5 <\/strong>X c\u00e2n\u00a0 n\u1eb7ng c\u01a1 th\u1ec3 (kg) \u1edf ph\u1ee5 n\u1eef h\u01a1n l\u00e0 <strong>0.6 <\/strong>X c\u00e2n n\u1eb7ng c\u01a1 th\u1ec3 (kg), \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho \u0111\u00e0n\u00a0 \u00f4ng. C\u0169ng l\u01b0u \u00fd r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n gi\u00e0 c\u00f3 t\u1ed5ng n\u01b0\u1edbc c\u01a1 th\u1ec3 gi\u1ea3m. M\u1ed9t b\u1ec7nh nh\u00e2n\u00a0 \u0111au n\u1eb1m vi\u1ec7n l\u00e2u ng\u00e0y c\u00f3 th\u1ec3 c\u00f3 t\u1ed5ng n\u01b0\u1edbc c\u01a1 th\u1ec3 th\u1ea5p h\u01a1n l\u01b0\u1ee3ng d\u1ef1 \u0111o\u00e1n d\u1ef1a tr\u00ean\u00a0 tu\u1ed5i v\u00e0 gi\u1edbi. Ch\u00eca kh\u00f3a l\u00e0 s\u1ef1 \u0111\u00e1nh gi\u00e1 th\u01b0\u1eddng xuy\u00ean n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh cho\u00a0 li\u1ec7u ph\u00e1p theo d\u00f5i. \u0110i\u1ec1u ch\u1ec9nh h\u1ea1 natri m\u00e1u c\u1ea5p v\u1edbi saline 3% l\u00e0 m\u1ed9t th\u1ee7 thu\u1eadt c\u1ea5p\u00a0 c\u1ee9u v\u00e0 th\u1ef1c hi\u1ec7n t\u1ed1t nh\u1ea5t d\u01b0\u1edbi s\u1ef1 quan s\u00e1t ch\u1eb7t ch\u1ebd v\u00e0 \u0111\u00e1nh gi\u00e1 th\u01b0\u1eddng xuy\u00ean n\u1ed3ng\u00a0 \u0111\u1ed9 natri cho li\u1ec7u ph\u00e1p theo d\u00f5i. T\u00f4i th\u00edch ki\u1ec3m so\u00e1t trong ICU \u0111\u1ed1i v\u1edbi \u0111i\u1ec1u n\u00e0y; n\u00f3i\u00a0 chung t\u00f4i t\u00ednh l\u01b0\u1ee3ng saline 3% cung c\u1ea5p trong kho\u1ea3ng th\u1eddi gian 4 gi\u1edd ban \u0111\u1ea7u v\u00e0\u00a0 \u0111\u00e1nh gi\u00e1 l\u1ea1i n\u1ed3ng \u0111\u1ed9 natri trong su\u1ed1t li\u1ec7u ph\u00e1p v\u00e0 l\u00fac k\u1ebft th\u00fac kho\u1ea3ng th\u1eddi gian n\u00e0y.\u00a0 T\u00f4i ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 natri m\u1ed7i 1-2 gi\u1edd cho li\u1ec7u ph\u00e1p theo d\u00f5i.<\/p>\n<p>M\u1ee5c \u0111\u00edch s\u1eed d\u1ee5ng saline 3% trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1ea1 natri m\u00e1u n\u1eb7ng c\u1ea5p t\u00ednh, c\u00f3\u00a0 tri\u1ec7u ch\u1ee9ng l\u00e0 kh\u00f4ng ph\u1ea3i \u0111i\u1ec1u ch\u1ec9nh n\u1ed3ng \u0111\u1ed9 natri m\u1ed7i gi\u00e2y, m\u00e0 l\u00e0 gi\u1ea3m t\u1ea1m th\u1eddi ph\u00f9\u00a0 n\u00e3o v\u00e0 ng\u0103n di ch\u1ee9ng th\u1ea7n kinh. T\u00f4i xem s\u1eed d\u1ee5ng saline 3% nh\u01b0 l\u00e0 c\u1ed1 g\u1eafng \u0111\u1ec3 \u201clet off<\/p>\n<p>m\u1ed9t \u00e1p l\u1ef1c nh\u1ecf\u201d b\u1edfi hi\u1ec7u qu\u1ea3 \u01b0u tr\u01b0\u01a1ng c\u1ee7a saline 3%, gi\u00fap di chuy\u1ec3n n\u01b0\u1edbc t\u1eeb n\u00e3o\u00a0 b\u1ecb ph\u00f9. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng \u0111i\u1ec1u ch\u1ec9nh n\u1ed3ng \u0111\u1ed9 natri v\u1edbi ch\u1ec9 6- 8 mEq\/L\u00a0 ban \u0111\u1ea7u. T\u00f4i kh\u00f4ng truy\u1ec1n saline 3% cho h\u01a1n 6-8 gi\u1edd. M\u1ed9t khi natri \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh\u00a0 v\u1edbi 6- 8 mEq\/gi\u1edd, n\u00f3i chung t\u00f4i d\u1eebng saline 3% v\u00e0 b\u1eaft \u0111\u1ea7u c\u00e1c bi\u1ec7n ph\u00e1p duy tr\u00ec h\u01a1n.<\/p>\n<p><strong>R\u1ea5t c\u1ea7n thi\u1ebft d\u00f9ng saline 3% \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh natri t\u1edbi m\u1ee9c g\u1ea7n v\u1edbi gi\u1edbi h\u1ea1n th\u01b0\u1eddng<\/strong>.\u00a0 \u0110i\u1ec1u ch\u1ec9nh qu\u00e1 m\u1ee9c l\u00e0 m\u1ed9t sai l\u1ea7m nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 g\u00e2y ODs. Nh\u1eefng v\u1ea5n \u0111\u1ec1 v\u1edbi ODs d\u01b0\u1eddng nh\u01b0 x\u1ea3y ra sau t\u1ed1t\u00a0 sau khi ph\u00f9 n\u00e3o \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh, do \u0111\u00f3 m\u1ed9t khi b\u1ec7nh nh\u00e2n \u0111\u00e3 ra kh\u1ecfi nguy hi\u1ec3m c\u1ee7a\u00a0 ph\u00f9 n\u00e3o, <strong>d\u1eebng <\/strong>saline \u01b0u tr\u01b0\u01a1ng v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c \u0111\u00e1nh gi\u00e1 ph\u00f9 h\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ea3o\u00a0 lu\u1eadn trong h\u1ea1 natri m\u00e1u m\u1ea1n. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i \u201cc\u00e1 nh\u00e2n h\u00f3a\u201d li\u1ec7u ph\u00e1p cho\u00a0 m\u1ed7i b\u1ec7nh nh\u00e2n, ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh h\u00ecnh l\u00e2m s\u00e0ng v\u00e0 t\u1ed1c \u0111\u1ed9 \u0111\u00e1p \u1ee9ng c\u1ee7a n\u1ed3ng \u0111\u1ed9\u00a0 natri huy\u1ebft thanh v\u1edbi truy\u1ec1n saline 3%. V\u00ed d\u1ee5, m\u1ed9t b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 co gi\u1eadt ti\u1ebfp\u00a0 di\u1ec5n c\u00f3 th\u1ec3 c\u1ea7n m\u1ed9t t\u1ed1c \u0111\u1ed9c \u0111i\u1ec1u ch\u1ec9nh ban \u0111\u1ea7u c\u1ee7a n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh nhanh\u00a0 h\u01a1n khuy\u1ebfn c\u00e1o 1 mEq\/gi\u1edd trong m\u1ed9t \u0111\u1ebfn hai gi\u1edd, t\u00f9y thu\u1ed9c \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a\u00a0 b\u1ec7nh nh\u00e2n v\u00e0 t\u1ed1c \u0111\u1ed9 t\u0103ng n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh.<\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong>\u00a0 <em>\u201cACID-BASE, FLUIDS, AND ELECTROLYTES MADE RIDICULOUSLY SIMPLE\u201d<\/em> ,\u00a0 \u00a0Richard A. Preston, M.D. M.B.A.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u c\u1ea5p, c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1eb7ng (l\u01a1 m\u01a1, h\u00f4n m\u00ea, co gi\u1eadt)\u00a0 c\u1ea7n theo d\u00f5i ch\u0103m s\u00f3c c\u1ea5p c\u1ee9u s\u00e1t sao. H\u1ea1n ch\u1ebf n\u01b0\u1edbc, m\u1eb7c d\u00f9 kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 \u0111i\u1ec1u\u00a0 ch\u1ec9nh h\u1ea1 natri m\u00e1u nhanh ch\u00f3ng \u0111\u1ee7 \u0111\u1ec3 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ph\u00f9 n\u00e3o, c\u0169ng s\u1ebd\u00a0 ng\u0103n c\u1ea3n h\u1ea1 [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb H\u1ea1 Natri m\u00e1u c\u1ea5p - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u c\u1ea5p, c\u00f3 tri\u1ec7u ch\u1ee9ng n\u1eb7ng (l\u01a1 m\u01a1, h\u00f4n m\u00ea, co gi\u1eadt)\u00a0 c\u1ea7n theo d\u00f5i ch\u0103m s\u00f3c c\u1ea5p c\u1ee9u s\u00e1t sao.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb H\u1ea1 Natri m\u00e1u c\u1ea5p - 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